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Tele- Ultrasound: Meeting Global Imaging Challenges

Breastfeeding Tips

By Lisa Dye • 05 Aug, 2021
Personal Breastfeeding Tips from our Certified Nurse-Midwife and Mom, Megan Chandler

#MyFertilityJourney

By Jessica Ivey • 26 Apr, 2021
It is " Infertility Awareness Week ." Does it surprise you to know that 1 in 8 couples are inflicted by some sort of infertility? You will notice throughout my story, I may use words different than what you are used to hearing. I will not say 1 in 8 "struggle", because that implies that if we fought just a little harder, struggled against it a little longer, we could change the outcome- which is obviously not the case. Infertility is not a "struggle," it is not a "fight," it is a medical problem that unfortunately afflicts many of us. Well-meaning friends and family may say "it will happen when you least expect it," or, "as soon as you stop trying you'll get pregnant." Well, quite honestly that is not true. Infertility is not something that can be changed by willpower, it is a medical condition that needs to be treated. Sometimes the cause of infertility can be pinpointed- I, for example, have one fallopian tube that is closed. But often there is no definitive reason. The conception of a child requires the combination of so many things to be perfectly in sync- it is no wonder so many couples cannot conceive! Hormones, endometrial health, ovarian health, egg count and age, and semen- all of this has to be functioning properly at the same time to allow a couple to become pregnant when they want. I will tell you our story. Thankfully, it has a happy ending. I met my husband, David, when I was 25 and got married at 27. At the time I was an anesthesiology resident at Georgetown University. We did not try for children right away. Working 80 hours a week and having a newborn did not feel feasible or enjoyable to me. And what little time off we did have we enjoyed going out and experiencing DC or traveling as much as we could afford. Fast forward a few years, I am now 30 and we have decided we want to start our family. Being a physician I knew it could take some time. I was not stressed the first month, or two, but after 6, 7, 8 months… I was both frustrated and concerned. Time seems to slip by when you are counting it in 4 week "cycles" tracking your period and peeing on a stick most mornings. Any couple who has actively tried to get pregnant knows the roller coaster: each month waiting to get the signal you're fertile, trying to conceive, hoping it worked, and then: either it does or it doesn't. And if it doesn't you are deflated but you know that next month- that could be it, that could be the month that it finally works! So you start all over again. Up and down, up and down. Please know, you are not alone on this roller coaster. Hopefully you have a supportive partner with you on the ride. But also, there are millions of women out there doing the same thing. If you are open about your experience you will likely find other women close to you that are on the ride with you. I will spare you all the details but we saw Elizabeth Irby, Women4Women CRNP, and did all the testing for myself and my husband. I do have a closed tube, but you should be able to get pregnant with just one tube so it is still partially unexplained. We tried fertility medication for a few months before deciding to move on to an infertility clinic. After conversation with our fertility specialist, Dr. Long, we opted to go forward with IVF using the invocelle. The invocelle is an awesome little device that allows you to incubate your embryos. After the eggs are fertilized, they are placed in a culture medium in the device and then inserted in the vagina where you incubate them for 5 days. Our first round we were so hopeful, we fertilized 3 good looking eggs. We went back after 5 days, and none of them had developed into usable embryos. I was not prepared for the level of heartbreak I felt at that moment. It was just a bunch of cells, right? But all of a sudden those 3 potential babies were gone in an instant from a glimpse at a microscope. And that was hard. My friends and family stepped up in a big way. I got flowers and well wishes and it bolstered us to try again. The second round of IVF worked. There is still a spot on my butt that is tender from all the progesterone injections, but I wouldn’t trade that for the world. Because our daughter, Rose, is now 4 months old and the most awesome part of our lives. She has a big gummy grin and chuckles like an old man and will completely melt your heart. Thankfully, I have had family and friends who were invested in this process with us. David and I made a conscious decision from the start to be open with those around us about what we were going through. You will be surprised when you start telling people what you are dealing with how many have their own story to contribute. We have made friendships built on the shared experience of infertility. I am glad we chose not to go through it alone. If you have not felt comfortable sharing with your friends and family, ask yourself why? Women have trouble recognizing that this is a disease inflicted upon them, not a failure. I have had the thought "if only I hadn't put off trying to get pregnant until after residency maybe we wouldn't have had to do IVF." But, maybe we would have? I will never know and guess what- it doesn't matter. There is no use thinking the "what ifs," or blaming yourself. I have never once blamed myself for having asthma, and I refuse to blame myself for having infertility. It is not your fault, it is not your body's fault. And that is why I believe Infertility Awareness Week is so important. I hope these stories empower women to be more open with their friends and families. You will be surprised- they want to be there for you, let them.

Endometriosis: Dispelling the Myths

By Allison Warren • 06 Mar, 2021
Most of us have heard of endometriosis at some point. Maybe you know a friend, a relative, or a coworker who has this diagnosis. However, there are a lot of misconceptions about what endometriosis actually is and how it affects patients. Endometriosis is a common, benign disorder that is estimated to affect approximately 10% of women. Endometriosis refers to a condition in which endometrial cells which normally line the uterine cavity are found outside of the uterine cavity. This disorder can come with a variety of symptoms or may be completely asymptomatic. Myth #1: Endometriosis just means you have very painful periods. It is true that the most common presenting symptom of endometriosis is painful periods (the medical term is dysmenorrhea). But as I’m sure many of you know, there are a number of conditions that can cause painful periods, such as uterine fibroids, polyps, ovarian cysts or masses, adhesions, or other disorders. In order to make a diagnosis of endometriosis, we first have to rule out all of these other conditions, which can often be challenging. One major challenge is that endometriosis typically cannot be seen with ultrasound or other imaging techniques. The gold standard for diagnosing this disorder is by performing a diagnostic surgery and actually visualizing or taking a biopsy of the lesions. So diagnosing endometriosis as the cause for painful periods is a lot more complicated than you might think! Myth #2: The more severe your symptoms, the more advanced the disease. As I just mentioned, some women with endometriosis have no pain at all and some have incapacitating pain. It stands to reason that people would believe that this reflects the degree of endometriosis they have. However, some of the worst cases of endometriosis I have seen have been in women who had no symptoms at all! Meanwhile, many of the patients with the worst pain have had only a couple small spots of endometriosis called “implants” when I did a laparoscopic surgery to look. The reason for this is not well known, but it is thought to be largely dependent upon the location of the implants and the degree of new nerve growth that has taken place around the implants. Myth #3: Endometriosis causes infertility. Yes, it is true that endometriosis is present in a large portion of women with infertility issues. One reason for this could be endometriosis on the fallopian tubes that distort or block the tubes. In reality, this is rarely the finding that we see during surgery. There are other theories, such as the presence of inflammation produced by the endometriosis implants, or somehow lowering a patient's reserve of good eggs. While fertility appears to be decreased in many women with endometriosis, it does not necessarily cause the need for IVF (in vitro fertilization). Myth #4: Endometriosis is caused by backward flow of period blood out of the fallopian tubes and into the abdominal cavity. While this is the prevailing theory about how endometriosis occurs, there are several other theories out there. In fact, this cannot be the only way that endometriosis occurs. If that is the only way it happens, then how has it ended up in lung tissue? It has also been found in girls as young as 8 years old who have not yet started menstruating. In fact, it has even been found in women who were born without a uterus! Myth #5: There is no effective treatment for endometriosis. This is simply not true. These implants are estrogen-dependent, which is the reason that the menstrual cycle stimulates their activity. However, this also means that they can be responsive to hormonal therapies. There are many different hormonal and hormone receptor treatments for endometriosis. While these therapies keep symptoms of endometriosis at bay, they do not cure the disorder. When these treatments are discontinued, symptoms often resume. Myth #6: The cure for endometriosis is hysterectomy. Removing the uterus alone often does not cure endometriosis. The ovaries must be removed as well, along with any endometriosis implants. Even when this surgery takes place, a small number of women will still have recurrence of some symptoms if some small implants remain. Myth #7: Endometriosis increases your risk for endometrial cancer. There is no genetic trait associated with endometriosis that has been shown to lead to cancer. There are some very rare types of ovarian cancers – clear cell and endometrioid cancer – that seem to be more common in women with endometriosis, but even with these rare cancers the risk is less than 1%. Therefore, there is no recommendation for increased cancer screening for women with endometriosis Allison Warren, MD
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